PATENT APPLICATION FEE DETERMINATION RECORD
: Effective October 1 , 2001
Application or Docket Number \ t
CLAIMS AS FILED - PART I
TOTAL CLAIMS ;
—
FOR
NUMBER FILED
NUMBER EXTRA
TOTAL CHARGEABLE CLAIMS
/5 minus 20=
*
INDEPENDENT CLAIMS " I
3 minus 3 =
* .....
MULTIPLE DEPENDENT CLAIM PRESENT
□
* If the difference in column 1 is less than zero, enter "0" in column 2
CLAIMS AS AMENDED - PART II
(Column 1)-
• (Column 2)
(Column 3)
ENTA
CLAIMS. . |
• REMAINING'
* -AFTER i
AMENDMENT
HIGHEST .
NUMBER |
* PREVIOUSLY ;
PAID FOR
PRESENT
EXTRA
Q
Z
Total : -
Minus J
**. -
LU
s
Independent,
* 1 > ■ • > i
Minus . p \
f . . > \
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
P
K X i
■ r' ' *
(Column 1)
(Column 2)
(Column 3)
ENTB
CLAIMS HWn
' REMAINING'' Bplffi^
AFTER B$^Pj4
AMENDMENT ■^SSK*}
HIGHEST
■ NUMBER ;
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
2
O
z
Total
Minus
** '
LU
s
Independent
*
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
(Column 1)
(Column 2)
(Column 3)
ENTC |
U
m
I CLAIMS
REMAINING
( AFTER
AMENDMENT
■
\ HIGHEST
NUMBER
PREVIOUSLY
PAID FOR
PRESENT
EXTRA
5
Q
Z
Total
Minus
**
£
Independent
Minus
<
FIRST PRESENTATION OF MULTIPLE DEPENDENT CLAIM
□
SMALL ENTITY OTHER THAN I
TYPE LZZI OR SMALL ENTITY*
* If the entry in column 1 is less than the entry in column 2, write "0" in column 3.
RATE
FEE
RATE
FEE.
BASIC FEE
370.00
OR
BASIC FEE
740.00
X$9=
OR
X$18=
\
X42=
OR
X84=
+140=
OR
+280=
TOTAL
OR
TOTAL
OTHER THAN !
SMALL ENTITY
OR
SMALL ENTITY?
ADDI-
ADDIr
. RATE
TIONAL
FEE
RATE
TIONAL
FEE
X$ 9=
OR
X$18=
•' X42= v
OR
- X84=
+140=
OR
+280=
TOTAL
ADDIT. FEE
OR
TOTAL
• - >
ADDI-
ADDIt
RATE
TIONAL
FEE
RATE
TIONAL
FEE
X$9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
ADDIT. FEE
OR
TOTAL
ADDIT. FEE
ADDI-
ADDI-
| RATE
TIONAL
FEE
RATE
TIONAL
FEE
X$9=
OR
X$18=
X42=
OR
X84=
+140=
OR
+280=
TOTAL
OR
TOTAL
ADDIT. FEE
*lf the "Highest Number Previously Paid For" IN THIS SPACE is less than 3, enter "3:
The "Highest Number Previously Paid For" (Total or Independent) is the highest number found in the appropriate box in column 1 .
FORMPTO-875 (Rev. 8/01)
Patent and Trademark Office, U.S. DEPARTMENT OF COMMERCE
OPO2001 462-1*4/ 59197